Aims
This analysis aims to investigate the risk of death or subsequent readmission in patients who have had an emergency hospital admission. It will help us understand what factors influence the risk of death or readmission, including determining variability between ICB area. This could help identify where activity might be mitigated through appropriate community services provision.
Methodology
Three patient cohorts are included within this analysis:
Elderly emergency: those 75 or over with an emergency admission.
Frail: those 65 or over with an emergency admission and a frailty score over 5. The frailty score is calculated from ICD-10 diagnoses recorded for admissions during the previous 2 years and using the risk scores in Gilbert et al (2018), Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. The Lancet, 391(10132), pp.1775-1782. (Note these patients are a subset for those in the elderly emergency cohort)
Falls: those 65 or over with an emergency admission related to a fall.
The End of life cohort are not included as by definition they die during their hospital admission.
Survival analysis has been conducted using data from 2022/23 for
Time to death (mortality)
Time to readmission (time to readmission from the first admission for all patients including some that will have died in the year post-admission)
Time to readmission- excluding those who died prior to readmission
Note: Frimley ICB has been removed from the analysis due to missing data.
Mortality
The time from when a patient first had an emergency admission and first entered the cohort until death was calculated. Those who died on the same day as their emergency admission when they first entered the cohort were excluded.
Trends in the percentage of deaths over time
The proportion of patients who die is higher within the elderly emergency and frail cohorts compared to the falls cohort.
Generally the proportion of deaths within either 28 days or 1 year have remained stable over time. A slightly lower percentage of deaths within 1 year is to be expected for those first admitted in 2023/24 as there is not a full year of follow-up and some deaths will have not yet occurred.
Summary of percentage of patients dying within 1 year (2022/23)
Elderly Emergency | Frail | Falls | |
|---|---|---|---|
Sex |
|
|
|
female | 158,781 (26.9%) | 117,967 (26.9%) | 19,996 (21.5%) |
male | 151,814 (31.7%) | 118,018 (30.8%) | 14,284 (30.9%) |
Age |
|
|
|
65-69 | N/A | 15,214 (16%) | 885 (9.6%) |
70-74 | N/A | 23,743 (19.3%) | 1,884 (13%) |
75-79 | 65,677 (20.1%) | 36,450 (22.9%) | 3,848 (16.9%) |
80-84 | 74,262 (25.3%) | 45,672 (28.3%) | 6,219 (22%) |
85-89 | 83,602 (32.7%) | 54,655 (35.2%) | 9,195 (27.9%) |
90+ | 87,054 (45.1%) | 60,251 (47%) | 12,249 (39%) |
Ethnicity |
|
|
|
Asian/Asian British | 6,521 (23.8%) | 5,353 (22.2%) | 484 (19.3%) |
Black/Black British | 3,228 (25.2%) | 2,521 (24.4%) | 229 (19.6%) |
Mixed | 660 (25%) | 572 (24.9%) | 64 (21.6%) |
Other | 3,126 (26.3%) | 2,480 (24.6%) | 315 (19.9%) |
White British | 257,148 (29.4%) | 194,921 (29.3%) | 28,789 (25.2%) |
White Other | 10,276 (28.1%) | 7,922 (27.8%) | 1,169 (23.1%) |
Unknown | 29,636 (28.4%) | 22,216 (27.1%) | 3,230 (22.4%) |
IMD decile |
|
|
|
1 | 26,468 (31.3%) | 22,398 (29.6%) | 2,898 (25.2%) |
2 | 27,682 (30.9%) | 22,692 (29.9%) | 3,260 (26%) |
3 | 28,332 (30.1%) | 22,496 (29.2%) | 3,210 (25.1%) |
4 | 31,182 (30.2%) | 23,778 (29.5%) | 3,401 (25.3%) |
5 | 32,184 (29.2%) | 24,374 (29.1%) | 3,488 (24.5%) |
6 | 33,531 (28.8%) | 24,890 (28.5%) | 3,735 (24.7%) |
7 | 34,270 (28.7%) | 25,238 (28.6%) | 3,737 (24.7%) |
8 | 33,722 (28.2%) | 24,869 (28.4%) | 3,611 (23.9%) |
9 | 32,720 (27.5%) | 23,706 (27.5%) | 3,666 (24.4%) |
10 | 30,504 (27%) | 21,544 (27%) | 3,274 (23.1%) |
|
|
| |
Total | 310,595 (29.1%) | 235,985 (28.7%) | 34,280 (24.6%) |
Comparing time to death between the cohorts using Kaplan-meier plot (2022/23)
For those first admitted in 2022/23 we considered the time to death from when the person was first admitted. The most recent year 2023/2024 was not used as there has not be sufficient time for those that entered the cohort at the end of this year to have a full year of follow-up time.
The risk of death is highest in the frail cohort, followed by the elderly emergency cohort, with those in the falls cohort have a lowest risk of death.
Kaplan Meier survival plots of time to death (2022/23)
ICB | Deaths | No. at risk | Percentage |
|---|---|---|---|
QRV: NHS North West London ICB | 7,111 | 29,342 | 24.2 |
QUY: NHS Bristol, N S'set & S Gloucs ICB | 4,839 | 17,961 | 26.9 |
QRL: NHS Hampshire And Isle Of Wight ICB | 11,089 | 41,017 | 27.0 |
QMJ: NHS North Central London ICB | 4,317 | 15,633 | 27.6 |
QHL: NHS Birmingham And Solihull ICB | 6,637 | 24,002 | 27.7 |
QNC: NHS Staffordshire & Stoke-On-Tr ICB | 7,241 | 26,098 | 27.7 |
QOX: NHS Bath & NE S'set, S'don & W ICB | 5,065 | 18,290 | 27.7 |
QXU: NHS Surrey Heartlands ICB | 6,163 | 22,254 | 27.7 |
QU9: NHS Bucks, Oxford & Berkshire W ICB | 8,288 | 29,859 | 27.8 |
QK1: NHS Leics, Leic'shire & Rutland ICB | 5,317 | 19,088 | 27.9 |
QVV: NHS Dorset ICB | 5,914 | 21,182 | 27.9 |
QOC: NHS Shrops, Telford & Wrekin ICB | 3,107 | 11,024 | 28.2 |
QJK: NHS Devon ICB | 8,178 | 28,784 | 28.4 |
QKS: NHS Kent And Medway ICB | 10,551 | 37,198 | 28.4 |
QKK: NHS South East London ICB | 6,492 | 22,696 | 28.6 |
QR1: NHS Gloucestershire ICB | 3,451 | 12,067 | 28.6 |
QWE: NHS South West London ICB | 5,628 | 19,703 | 28.6 |
QMF: NHS North East London ICB | 5,715 | 19,918 | 28.7 |
QSL: NHS Somerset ICB | 4,231 | 14,692 | 28.8 |
QT6: NHS Cornwall & Isles Of Scilly ICB | 3,078 | 10,670 | 28.8 |
QHM: NHS North East & North Cumbria ICB | 20,584 | 70,998 | 29.0 |
QWU: NHS Coventry And Warwickshire ICB | 5,646 | 19,453 | 29.0 |
QNX: NHS Sussex ICB | 11,294 | 38,875 | 29.1 |
QHG: NHS Beds, Luton & Milton Keynes ICB | 4,697 | 16,045 | 29.3 |
QUA: NHS Black Country ICB | 7,696 | 26,260 | 29.3 |
QM7: NHS Hertfordshire & West Essex ICB | 8,321 | 28,276 | 29.4 |
QYG: NHS Cheshire And Merseyside ICB | 15,964 | 54,391 | 29.4 |
QJ2: NHS Derby And Derbyshire ICB | 6,934 | 23,505 | 29.5 |
QF7: NHS South Yorkshire ICB | 8,775 | 29,424 | 29.8 |
QE1: NHS Lancashire & South Cumbria ICB | 11,140 | 37,233 | 29.9 |
QPM: NHS Northamptonshire ICB | 4,213 | 14,111 | 29.9 |
QH8: NHS Mid And South Essex ICB | 7,523 | 24,890 | 30.2 |
QJM: NHS Lincolnshire ICB | 5,139 | 17,010 | 30.2 |
QJG: NHS Suffolk & North East Essex ICB | 6,913 | 22,736 | 30.4 |
QOQ: NHS Humber And North Yorkshire ICB | 11,800 | 38,865 | 30.4 |
QUE: NHS Cambs & Peterborough ICB | 5,041 | 16,461 | 30.6 |
QGH: NHS Herefords & Worcestershire ICB | 4,909 | 16,003 | 30.7 |
QOP: NHS Greater Manchester ICB | 15,127 | 49,098 | 30.8 |
QT1: NHS Nott'ham & Nottinghamshire ICB | 6,628 | 21,522 | 30.8 |
QWO: NHS West Yorkshire ICB | 12,907 | 41,047 | 31.4 |
QMM: NHS Norfolk And Waveney ICB | 7,598 | 23,897 | 31.8 |
ICB | Deaths | No. at risk | Percentage |
|---|---|---|---|
QT6: NHS Cornwall & Isles Of Scilly ICB | 230 | 1,199 | 19.2 |
QMJ: NHS North Central London ICB | 503 | 2,542 | 19.8 |
QRV: NHS North West London ICB | 848 | 4,080 | 20.8 |
QOX: NHS Bath & NE S'set, S'don & W ICB | 544 | 2,488 | 21.9 |
QOC: NHS Shrops, Telford & Wrekin ICB | 286 | 1,294 | 22.1 |
QU9: NHS Bucks, Oxford & Berkshire W ICB | 843 | 3,754 | 22.5 |
QKS: NHS Kent And Medway ICB | 755 | 3,305 | 22.8 |
QWE: NHS South West London ICB | 661 | 2,893 | 22.8 |
QNX: NHS Sussex ICB | 1,254 | 5,485 | 22.9 |
QRL: NHS Hampshire And Isle Of Wight ICB | 1,392 | 6,056 | 23.0 |
QNC: NHS Staffordshire & Stoke-On-Tr ICB | 646 | 2,749 | 23.5 |
QXU: NHS Surrey Heartlands ICB | 678 | 2,869 | 23.6 |
QKK: NHS South East London ICB | 987 | 4,167 | 23.7 |
QVV: NHS Dorset ICB | 635 | 2,659 | 23.9 |
QYG: NHS Cheshire And Merseyside ICB | 1,609 | 6,724 | 23.9 |
QJK: NHS Devon ICB | 770 | 3,206 | 24.0 |
QJ2: NHS Derby And Derbyshire ICB | 594 | 2,467 | 24.1 |
QMF: NHS North East London ICB | 821 | 3,392 | 24.2 |
QJM: NHS Lincolnshire ICB | 508 | 2,085 | 24.4 |
QT1: NHS Nott'ham & Nottinghamshire ICB | 648 | 2,648 | 24.5 |
QGH: NHS Herefords & Worcestershire ICB | 532 | 2,160 | 24.6 |
QHM: NHS North East & North Cumbria ICB | 2,203 | 8,901 | 24.8 |
QUE: NHS Cambs & Peterborough ICB | 561 | 2,257 | 24.9 |
QSL: NHS Somerset ICB | 467 | 1,859 | 25.1 |
QE1: NHS Lancashire & South Cumbria ICB | 1,242 | 4,929 | 25.2 |
QJG: NHS Suffolk & North East Essex ICB | 748 | 2,949 | 25.4 |
QM7: NHS Hertfordshire & West Essex ICB | 983 | 3,867 | 25.4 |
QPM: NHS Northamptonshire ICB | 468 | 1,844 | 25.4 |
QHL: NHS Birmingham And Solihull ICB | 714 | 2,803 | 25.5 |
QK1: NHS Leics, Leic'shire & Rutland ICB | 599 | 2,318 | 25.8 |
QWU: NHS Coventry And Warwickshire ICB | 655 | 2,539 | 25.8 |
QOP: NHS Greater Manchester ICB | 1,656 | 6,383 | 25.9 |
QHG: NHS Beds, Luton & Milton Keynes ICB | 639 | 2,427 | 26.3 |
QOQ: NHS Humber And North Yorkshire ICB | 1,165 | 4,415 | 26.4 |
QWO: NHS West Yorkshire ICB | 1,470 | 5,489 | 26.8 |
QMM: NHS Norfolk And Waveney ICB | 911 | 3,380 | 27.0 |
QR1: NHS Gloucestershire ICB | 414 | 1,523 | 27.2 |
QF7: NHS South Yorkshire ICB | 1,016 | 3,727 | 27.3 |
QUA: NHS Black Country ICB | 966 | 3,525 | 27.4 |
QUY: NHS Bristol, N S'set & S Gloucs ICB | 704 | 2,573 | 27.4 |
QH8: NHS Mid And South Essex ICB | 1,046 | 3,649 | 28.7 |
ICB | Deaths | No. at risk | Percentage |
|---|---|---|---|
QRV: NHS North West London ICB | 5,721 | 24,250 | 23.6 |
QOX: NHS Bath & NE S'set, S'don & W ICB | 3,471 | 13,075 | 26.5 |
QNC: NHS Staffordshire & Stoke-On-Tr ICB | 5,512 | 20,688 | 26.6 |
QXU: NHS Surrey Heartlands ICB | 4,447 | 16,721 | 26.6 |
QVV: NHS Dorset ICB | 4,065 | 15,111 | 26.9 |
QHL: NHS Birmingham And Solihull ICB | 5,082 | 18,771 | 27.1 |
QUY: NHS Bristol, N S'set & S Gloucs ICB | 3,654 | 13,473 | 27.1 |
QRL: NHS Hampshire And Isle Of Wight ICB | 8,134 | 29,919 | 27.2 |
QU9: NHS Bucks, Oxford & Berkshire W ICB | 6,232 | 22,657 | 27.5 |
QMJ: NHS North Central London ICB | 3,329 | 12,015 | 27.7 |
QK1: NHS Leics, Leic'shire & Rutland ICB | 4,007 | 14,401 | 27.8 |
QWE: NHS South West London ICB | 4,383 | 15,728 | 27.9 |
QT6: NHS Cornwall & Isles Of Scilly ICB | 2,101 | 7,494 | 28.0 |
QKK: NHS South East London ICB | 5,318 | 18,941 | 28.1 |
QOC: NHS Shrops, Telford & Wrekin ICB | 2,322 | 8,266 | 28.1 |
QSL: NHS Somerset ICB | 3,041 | 10,841 | 28.1 |
QHM: NHS North East & North Cumbria ICB | 16,130 | 57,065 | 28.3 |
QR1: NHS Gloucestershire ICB | 2,432 | 8,537 | 28.5 |
QNX: NHS Sussex ICB | 8,312 | 29,057 | 28.6 |
QJK: NHS Devon ICB | 5,813 | 20,270 | 28.7 |
QMF: NHS North East London ICB | 4,610 | 16,078 | 28.7 |
QYG: NHS Cheshire And Merseyside ICB | 12,764 | 44,434 | 28.7 |
QKS: NHS Kent And Medway ICB | 7,140 | 24,797 | 28.8 |
QUA: NHS Black Country ICB | 6,048 | 20,990 | 28.8 |
QHG: NHS Beds, Luton & Milton Keynes ICB | 3,616 | 12,450 | 29.0 |
QF7: NHS South Yorkshire ICB | 6,710 | 22,908 | 29.3 |
QJM: NHS Lincolnshire ICB | 3,874 | 13,220 | 29.3 |
QM7: NHS Hertfordshire & West Essex ICB | 6,252 | 21,310 | 29.3 |
QWU: NHS Coventry And Warwickshire ICB | 4,424 | 15,123 | 29.3 |
QJ2: NHS Derby And Derbyshire ICB | 5,246 | 17,797 | 29.5 |
QH8: NHS Mid And South Essex ICB | 5,806 | 19,418 | 29.9 |
QE1: NHS Lancashire & South Cumbria ICB | 8,728 | 28,924 | 30.2 |
QOP: NHS Greater Manchester ICB | 11,979 | 39,638 | 30.2 |
QPM: NHS Northamptonshire ICB | 3,411 | 11,307 | 30.2 |
QOQ: NHS Humber And North Yorkshire ICB | 8,940 | 29,499 | 30.3 |
QWO: NHS West Yorkshire ICB | 10,110 | 33,171 | 30.5 |
QT1: NHS Nott'ham & Nottinghamshire ICB | 5,140 | 16,821 | 30.6 |
QUE: NHS Cambs & Peterborough ICB | 3,899 | 12,688 | 30.7 |
QGH: NHS Herefords & Worcestershire ICB | 3,652 | 11,825 | 30.9 |
QJG: NHS Suffolk & North East Essex ICB | 5,161 | 16,517 | 31.2 |
QMM: NHS Norfolk And Waveney ICB | 5,522 | 17,639 | 31.3 |
Multivariate survival analysis of time to death (2022/23)
For this analysis we have taken only data from 2022-2023, and only the first admission for each patient. We have excluded admissions where the person died on the day of admission.
We have fitted multivariate Cox proportional hazard models to our data to assess how various factors independently affect the risk of readmission occurring over time.
Assumptions of Cox proportional hazards models
Cox proportional hazards models assume that the hazard rate (in this case risk of death) for a person with one set of covariates is proportional to the hazard rate for a person with a different set of covariates, so that the hazard ratio is assumed to be constant over time.
The proportional hazards (PH) assumption can be checked using statistical tests and graphical diagnostics based on the scaled Schoenfeld residuals.
We find significant p-values for some covariates, particularly for ICBs, indicating that the data violates the proportional hazards assumption. This is unsurprising as we have very high number of patients included within our dataset, which means even very small deviations in the residuals over time can result in significant p-values.
Plotting a smoothed fit to the Schoenfeld residuals allows us to determine, where p-values are significant, whether the changes in the beta coefficient over time are large enough to meaningfully impact our analyses. Deviations from a horizontal line indicate non-proportional hazards, and that the hazard ratio will be changing over time.
There are alternatives when the proportional hazards assumption is violated such as adding a time interaction into the model or using an alternative accelerated failure model. With the size of our dataset and the number of covariates (over 40 ICBs) the alternatives do not appear feasible and would unlikely add useful information to our conclusions.
Considering these factors and that for this analysis the degree of variation and trends are more important than the absolute hazard ratios we have used a Cox proportional hazards models, and the calculated hazard ratios can be considered as a time-averaged hazard ratio. We have modelled the risk of death within 28 days and within 1 yr. Considering the first 28 day period alongside the 1 year time period means we can check for any initial differences in the first 28 days that might be averaged out in the long 1 year period. There are some differences in the hazard ratios calculated for the two models, but the general trends are consistent.
Elderly emergency
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 41.2493 1 0.0000 *
age_range 150.1131 1 0.0000 *
ethnicity 0.2715 1 0.6023
imd_decile 0.0999 1 0.7520
icb 1.3890 1 0.2386
GLOBAL 243.3581 59 0.0000 *
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 38.1467 1 0.0000 *
age_range 396.9170 1 0.0000 *
ethnicity 0.0115 1 0.9146
imd_decile 1.6895 1 0.1937
icb 1.5642 1 0.2111
GLOBAL 689.5564 59 0.0000 *
Falls
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 0.0269 1 0.8696
age_range 400.3599 1 0.0000 *
ethnicity 0.3301 1 0.5656
imd_decile 0.0387 1 0.8441
icb 96.5997 1 0.0000 *
GLOBAL 87.4781 61 0.0148 *
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 0.3263 1 0.5678
age_range 1138.7820 1 0.0000 *
ethnicity 0.0002 1 0.9881
imd_decile 0.0035 1 0.9526
icb 1.3590 1 0.2437
GLOBAL 213.6630 61 0.0000 *
Frail
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 22.3987 1 0.0000 *
age_range 5932.7015 1 0.0000 *
ethnicity 0.0645 1 0.7995
imd_decile 0.6659 1 0.4145
icb 0.9446 1 0.3311
GLOBAL 345.5420 61 0.0000 *
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 23.8176 1 0.0000 *
age_range 3445.9465 1 0.0000 *
ethnicity 0.2245 1 0.6356
imd_decile 0.0106 1 0.9178
icb 1.5006 1 0.2206
GLOBAL 528.0278 61 0.0000 *
Number of deaths on day of admission by ethnicity
For the survival analysis we excluded anyone who died on the day of first admission, so given the differences seen in the risk of death by ethnicity we have checked whether there are differences in the percentage of patients who die on the day of first admission by ethnicity.
Ethnicity | Percentage who die on day of admissions |
|---|---|
White British | 0.33 |
Asian/Asian British | 0.33 |
Black/Black British | 0.33 |
Mixed | 0.30 |
Other | 0.25 |
White Other | 0.27 |
Unknown | 0.44 |
The percentage of patient who die on the day of admission is slightly higher for those who are Asian/Asian British and of Unknown ethnicity compared to those who are White British.
Readmissions
Trends in the percentage of admissions with a subsequent readmission over time
Generally the proportion of admissions that have resulted in a readmission within either 28 days or 1 year have remained stable over time.
The proportion of patient with a readmission is higher in the elderly emergency and frail cohorts compared to the falls cohort.
A lower percentage of readmissions within 1 year is to be expected for those admitted in 2023/24 as there is not a full year of follow-up and some readmissions will have not yet occurred.
Summary of percentage of patients readmitted within 1 year (2022/23)
All admissions are counted an individual events, so some patients with multiple admissions will be included more than once.
Elderly Emergency | Frail | Falls | |
|---|---|---|---|
Sex |
|
|
|
female | 275,117 (30.6%) | 166,668 (29.4%) | 21,796 (21.7%) |
male | 277,615 (36.4%) | 173,647 (33.9%) | 15,633 (31.2%) |
Age |
|
|
|
65-69 | N/A | 22,486 (18.8%) | 966 (9.8%) |
70-74 | N/A | 35,020 (22.3%) | 2,048 (13.2%) |
75-79 | 122,350 (24.8%) | 53,864 (26%) | 4,190 (17.1%) |
80-84 | 136,797 (29.8%) | 66,343 (31%) | 6,819 (22.3%) |
85-89 | 148,913 (36.7%) | 78,824 (37.8%) | 10,065 (28.1%) |
90+ | 144,672 (47.6%) | 83,778 (48.6%) | 13,341 (38.8%) |
Ethnicity |
|
|
|
Asian/Asian British | 12,444 (28.2%) | 8,031 (25.3%) | 526 (19.5%) |
Black/Black British | 6,225 (29.6%) | 3,872 (27.5%) | 252 (19.4%) |
Mixed | 1,239 (29.8%) | 858 (28.5%) | 73 (22.3%) |
Other | 5,554 (30.3%) | 3,503 (26.8%) | 354 (20.3%) |
White British | 459,853 (33.7%) | 281,826 (32.1%) | 31,434 (25.4%) |
White Other | 18,946 (32.4%) | 11,678 (30.6%) | 1,280 (23%) |
Unknown | 48,471 (32.4%) | 30,547 (29.9%) | 3,510 (22.9%) |
IMD decile |
|
|
|
1 | 49,177 (35.7%) | 32,826 (32.3%) | 3,116 (25%) |
2 | 51,303 (35.2%) | 33,762 (32.9%) | 3,582 (26.1%) |
3 | 52,017 (34.5%) | 33,125 (32.2%) | 3,558 (25.5%) |
4 | 55,425 (34.3%) | 34,205 (32.2%) | 3,711 (25.4%) |
5 | 57,084 (33.4%) | 34,999 (31.8%) | 3,796 (24.7%) |
6 | 59,006 (33%) | 35,802 (31.4%) | 4,070 (24.9%) |
7 | 59,835 (32.7%) | 35,850 (31.3%) | 4,050 (24.8%) |
8 | 59,305 (32.4%) | 35,482 (31.2%) | 3,972 (24.3%) |
9 | 56,965 (31.6%) | 33,744 (30.3%) | 4,007 (24.7%) |
10 | 52,615 (31%) | 30,520 (29.8%) | 3,567 (23.4%) |
|
|
| |
Total | 552,732 (33.3%) | 340,315 (31.5%) | 37,429 (24.8%) |
Number of readmissions in 2022/2023
cohort | mean | median | min | lower quartile | upper quartile | max |
|---|---|---|---|---|---|---|
elderly emergency | 0.55 | 0 | 0 | 0 | 1 | 67 |
falls | 0.08 | 0 | 0 | 0 | 0 | 7 |
frail | 0.31 | 0 | 0 | 0 | 0 | 36 |
The majority of patients have no readmission within a year, and of those that do have a readmission it is most common to just have a single readmission. A small number of patients are having more regular emergency admissions; those with a highest rates appear to be often admitted and discharged on the same day.
Comparing time to readmission between the cohorts using Kaplan-meier plots (2022/23)
Survival analysis was conducted where each admission is treated as an independent event. This means some patients who had multiple admissions within 2022/23 will be included multiple times.
Survival analysis was conducted using a patient’s first admission within 2022/23, so only one event is included per patient, even if the patient has multiple admissions over the year.
The risk of readmission is very similar between the elderly emergency and frail cohorts (note the frail cohort is a subset of the elderly emergency cohort). Those in the falls cohort have a lower risk of readmission.
The risk of admissions is increased slightly by a small subset of patients that have multiple readmissions, as the risk of readmission decreases if only the first admission/ readmission is included for each patient.
Kaplan Meier survival plots of time to readmission (2022/23)
For these plots each admission in 2022/23 was treated as an independent event, meaning that some patients who had multiple admissions within 2022/23 will be included multiple times.
ICB | Readmissions | No. at risk | Percentage |
|---|---|---|---|
QR1: NHS Gloucestershire ICB | 7,538 | 17,057 | 44.2 |
QT6: NHS Cornwall & Isles Of Scilly ICB | 6,612 | 14,681 | 45.0 |
QVV: NHS Dorset ICB | 14,623 | 31,973 | 45.7 |
QOC: NHS Shrops, Telford & Wrekin ICB | 7,782 | 16,293 | 47.8 |
QGH: NHS Herefords & Worcestershire ICB | 11,357 | 23,706 | 47.9 |
QMM: NHS Norfolk And Waveney ICB | 16,713 | 34,847 | 48.0 |
QJM: NHS Lincolnshire ICB | 12,130 | 25,241 | 48.1 |
QOX: NHS Bath & NE S'set, S'don & W ICB | 13,053 | 27,036 | 48.3 |
QJG: NHS Suffolk & North East Essex ICB | 16,829 | 34,195 | 49.2 |
QNX: NHS Sussex ICB | 28,798 | 58,172 | 49.5 |
QJK: NHS Devon ICB | 21,323 | 42,920 | 49.7 |
QE1: NHS Lancashire & South Cumbria ICB | 27,931 | 55,937 | 49.9 |
QSL: NHS Somerset ICB | 11,022 | 22,076 | 49.9 |
QKS: NHS Kent And Medway ICB | 28,752 | 57,557 | 50.0 |
QK1: NHS Leics, Leic'shire & Rutland ICB | 14,608 | 28,846 | 50.6 |
QOQ: NHS Humber And North Yorkshire ICB | 30,373 | 59,446 | 51.1 |
QT1: NHS Nott'ham & Nottinghamshire ICB | 16,915 | 32,881 | 51.4 |
QWO: NHS West Yorkshire ICB | 32,617 | 63,464 | 51.4 |
QU9: NHS Bucks, Oxford & Berkshire W ICB | 24,114 | 46,592 | 51.8 |
QH8: NHS Mid And South Essex ICB | 20,108 | 38,759 | 51.9 |
QM7: NHS Hertfordshire & West Essex ICB | 22,898 | 44,110 | 51.9 |
QUY: NHS Bristol, N S'set & S Gloucs ICB | 14,302 | 27,504 | 52.0 |
QYG: NHS Cheshire And Merseyside ICB | 43,588 | 83,759 | 52.0 |
QOP: NHS Greater Manchester ICB | 40,329 | 76,617 | 52.6 |
QMJ: NHS North Central London ICB | 12,730 | 24,146 | 52.7 |
QHG: NHS Beds, Luton & Milton Keynes ICB | 13,493 | 25,501 | 52.9 |
QRL: NHS Hampshire And Isle Of Wight ICB | 33,940 | 64,205 | 52.9 |
QWE: NHS South West London ICB | 16,393 | 30,997 | 52.9 |
QWU: NHS Coventry And Warwickshire ICB | 16,336 | 30,824 | 53.0 |
QXU: NHS Surrey Heartlands ICB | 18,816 | 35,481 | 53.0 |
QUE: NHS Cambs & Peterborough ICB | 14,133 | 26,315 | 53.7 |
QJ2: NHS Derby And Derbyshire ICB | 20,582 | 37,959 | 54.2 |
QUA: NHS Black Country ICB | 22,677 | 41,709 | 54.4 |
QHM: NHS North East & North Cumbria ICB | 62,334 | 114,454 | 54.5 |
QNC: NHS Staffordshire & Stoke-On-Tr ICB | 22,617 | 41,333 | 54.7 |
QHL: NHS Birmingham And Solihull ICB | 21,020 | 38,199 | 55.0 |
QMF: NHS North East London ICB | 18,429 | 32,989 | 55.9 |
QF7: NHS South Yorkshire ICB | 26,758 | 47,738 | 56.1 |
QKK: NHS South East London ICB | 21,158 | 37,627 | 56.2 |
QPM: NHS Northamptonshire ICB | 13,206 | 23,500 | 56.2 |
QRV: NHS North West London ICB | 28,710 | 49,403 | 58.1 |
ICB | Readmissions | No. at risk | Percentage |
|---|---|---|---|
QT6: NHS Cornwall & Isles Of Scilly ICB | 443 | 1,252 | 35.4 |
QR1: NHS Gloucestershire ICB | 572 | 1,606 | 35.6 |
QOC: NHS Shrops, Telford & Wrekin ICB | 518 | 1,344 | 38.5 |
QGH: NHS Herefords & Worcestershire ICB | 925 | 2,311 | 40.0 |
QJK: NHS Devon ICB | 1,380 | 3,351 | 41.2 |
QJM: NHS Lincolnshire ICB | 914 | 2,213 | 41.3 |
QK1: NHS Leics, Leic'shire & Rutland ICB | 1,024 | 2,435 | 42.1 |
QSL: NHS Somerset ICB | 857 | 1,996 | 42.9 |
QMM: NHS Norfolk And Waveney ICB | 1,546 | 3,599 | 43.0 |
QOX: NHS Bath & NE S'set, S'don & W ICB | 1,169 | 2,677 | 43.7 |
QE1: NHS Lancashire & South Cumbria ICB | 2,316 | 5,263 | 44.0 |
QOQ: NHS Humber And North Yorkshire ICB | 2,061 | 4,683 | 44.0 |
QVV: NHS Dorset ICB | 1,279 | 2,874 | 44.5 |
QJG: NHS Suffolk & North East Essex ICB | 1,420 | 3,170 | 44.8 |
QNX: NHS Sussex ICB | 2,675 | 5,928 | 45.1 |
QJ2: NHS Derby And Derbyshire ICB | 1,171 | 2,593 | 45.2 |
QT1: NHS Nott'ham & Nottinghamshire ICB | 1,293 | 2,831 | 45.7 |
QU9: NHS Bucks, Oxford & Berkshire W ICB | 1,857 | 4,040 | 46.0 |
QWO: NHS West Yorkshire ICB | 2,759 | 5,867 | 47.0 |
QUY: NHS Bristol, N S'set & S Gloucs ICB | 1,333 | 2,800 | 47.6 |
QYG: NHS Cheshire And Merseyside ICB | 3,414 | 7,141 | 47.8 |
QMJ: NHS North Central London ICB | 1,358 | 2,785 | 48.8 |
QKS: NHS Kent And Medway ICB | 1,790 | 3,642 | 49.1 |
QOP: NHS Greater Manchester ICB | 3,352 | 6,824 | 49.1 |
QM7: NHS Hertfordshire & West Essex ICB | 2,077 | 4,211 | 49.3 |
QHM: NHS North East & North Cumbria ICB | 4,772 | 9,638 | 49.5 |
QXU: NHS Surrey Heartlands ICB | 1,555 | 3,132 | 49.6 |
QUE: NHS Cambs & Peterborough ICB | 1,243 | 2,462 | 50.5 |
QHG: NHS Beds, Luton & Milton Keynes ICB | 1,363 | 2,681 | 50.8 |
QWU: NHS Coventry And Warwickshire ICB | 1,413 | 2,776 | 50.9 |
QH8: NHS Mid And South Essex ICB | 2,050 | 4,017 | 51.0 |
QF7: NHS South Yorkshire ICB | 2,098 | 4,060 | 51.7 |
QNC: NHS Staffordshire & Stoke-On-Tr ICB | 1,523 | 2,935 | 51.9 |
QRL: NHS Hampshire And Isle Of Wight ICB | 3,505 | 6,745 | 52.0 |
QUA: NHS Black Country ICB | 2,004 | 3,857 | 52.0 |
QWE: NHS South West London ICB | 1,666 | 3,204 | 52.0 |
QHL: NHS Birmingham And Solihull ICB | 1,585 | 3,007 | 52.7 |
QPM: NHS Northamptonshire ICB | 1,085 | 2,016 | 53.8 |
QMF: NHS North East London ICB | 2,087 | 3,864 | 54.0 |
QRV: NHS North West London ICB | 2,484 | 4,569 | 54.4 |
QKK: NHS South East London ICB | 2,702 | 4,756 | 56.8 |
ICB | Readmissions | No. at risk | Percentage |
|---|---|---|---|
QR1: NHS Gloucestershire ICB | 4,229 | 10,449 | 40.5 |
QT6: NHS Cornwall & Isles Of Scilly ICB | 3,715 | 9,002 | 41.3 |
QVV: NHS Dorset ICB | 8,213 | 19,215 | 42.7 |
QOC: NHS Shrops, Telford & Wrekin ICB | 4,528 | 10,308 | 43.9 |
QJM: NHS Lincolnshire ICB | 7,508 | 16,864 | 44.5 |
QGH: NHS Herefords & Worcestershire ICB | 6,758 | 15,078 | 44.8 |
QMM: NHS Norfolk And Waveney ICB | 9,940 | 22,141 | 44.9 |
QOX: NHS Bath & NE S'set, S'don & W ICB | 7,643 | 16,719 | 45.7 |
QJK: NHS Devon ICB | 11,802 | 25,526 | 46.2 |
QSL: NHS Somerset ICB | 6,411 | 13,818 | 46.4 |
QE1: NHS Lancashire & South Cumbria ICB | 17,297 | 37,117 | 46.6 |
QJG: NHS Suffolk & North East Essex ICB | 9,961 | 21,267 | 46.8 |
QK1: NHS Leics, Leic'shire & Rutland ICB | 8,621 | 18,422 | 46.8 |
QNX: NHS Sussex ICB | 17,634 | 37,642 | 46.8 |
QKS: NHS Kent And Medway ICB | 15,246 | 32,496 | 46.9 |
QOQ: NHS Humber And North Yorkshire ICB | 17,918 | 37,982 | 47.2 |
QT1: NHS Nott'ham & Nottinghamshire ICB | 10,601 | 21,955 | 48.3 |
QH8: NHS Mid And South Essex ICB | 12,407 | 25,602 | 48.5 |
QU9: NHS Bucks, Oxford & Berkshire W ICB | 14,518 | 29,853 | 48.6 |
QWO: NHS West Yorkshire ICB | 21,157 | 43,545 | 48.6 |
QHG: NHS Beds, Luton & Milton Keynes ICB | 7,893 | 16,223 | 48.7 |
QM7: NHS Hertfordshire & West Essex ICB | 13,667 | 27,985 | 48.8 |
QOP: NHS Greater Manchester ICB | 25,408 | 51,928 | 48.9 |
QUY: NHS Bristol, N S'set & S Gloucs ICB | 8,593 | 17,524 | 49.0 |
QYG: NHS Cheshire And Merseyside ICB | 28,657 | 58,494 | 49.0 |
QMJ: NHS North Central London ICB | 7,837 | 15,782 | 49.7 |
QWE: NHS South West London ICB | 10,510 | 21,047 | 49.9 |
QWU: NHS Coventry And Warwickshire ICB | 10,095 | 20,184 | 50.0 |
QXU: NHS Surrey Heartlands ICB | 11,267 | 22,544 | 50.0 |
QHM: NHS North East & North Cumbria ICB | 38,245 | 75,965 | 50.3 |
QRL: NHS Hampshire And Isle Of Wight ICB | 20,006 | 39,710 | 50.4 |
QUA: NHS Black Country ICB | 14,083 | 27,911 | 50.5 |
QUE: NHS Cambs & Peterborough ICB | 8,632 | 17,067 | 50.6 |
QHL: NHS Birmingham And Solihull ICB | 12,592 | 24,665 | 51.1 |
QNC: NHS Staffordshire & Stoke-On-Tr ICB | 14,103 | 27,412 | 51.4 |
QJ2: NHS Derby And Derbyshire ICB | 12,601 | 24,212 | 52.0 |
QF7: NHS South Yorkshire ICB | 15,998 | 30,700 | 52.1 |
QMF: NHS North East London ICB | 11,630 | 22,205 | 52.4 |
QKK: NHS South East London ICB | 14,170 | 26,579 | 53.3 |
QRV: NHS North West London ICB | 17,882 | 33,377 | 53.6 |
QPM: NHS Northamptonshire ICB | 8,465 | 15,729 | 53.8 |
Multivariate survival analysis of time to readmission (2022/23)
For this analysis we have taken only data from 2022-2023, and only the first admission/time to readmission for each patient.
We have fitted Cox proportional hazard models to our data to assess how various factors independently affect the risk of readmission occurring over time.
For information on the testing of the proportional hazards assumption see Section 1.5.1.
We have used a Cox proportional hazards models and the calculated hazard ratios can be considered as a time-averaged hazard ratio. We have considered models for readmission within 28 days and within 1 yr. There are some differences between the hazard ratios calculated for the two models, but the general trends are consistent.
Elderly emergency
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 0.5985 1 0.4391
age_range 0.0000 1 0.9997
ethnicity 0.3326 1 0.5641
imd_decile 0.1206 1 0.7284
icb 26.2954 1 0.0000 *
GLOBAL 648.1661 59 0.0000 *
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 286.7574 1 0.0000 *
age_range 0.3894 1 0.5326
ethnicity 0.2177 1 0.6408
imd_decile 2.6653 1 0.1026
icb 3.9941 1 0.0457 *
GLOBAL 1147.1447 59 0.0000 *
Falls
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 3.2766 1 0.0703
age_range 34.8998 1 0.0000 *
ethnicity 0.0642 1 0.8000
imd_decile 0.3033 1 0.5818
icb 13.2508 1 0.0003 *
GLOBAL 115.2325 61 0.0000 *
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 7.3360 1 0.0068 *
age_range 16.1494 1 0.0001 *
ethnicity 0.0009 1 0.9757
imd_decile 0.0803 1 0.7769
icb 18.6529 1 0.0000 *
GLOBAL 109.3210 61 0.0001 *
Frail
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 1.5728 1 0.2098
age_range 1.7869 1 0.1813
ethnicity 0.3570 1 0.5502
imd_decile 0.0945 1 0.7585
icb 104.4060 1 0.0000 *
GLOBAL 532.4705 61 0.0000 *
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 158.5625 1 0.0000 *
age_range 436.9416 1 0.0000 *
ethnicity 0.2432 1 0.6219
imd_decile 3.4745 1 0.0623
icb 4.6099 1 0.0318 *
GLOBAL 1178.8713 61 0.0000 *
Readmissions- excluding those who died prior to readmission
In the previous analysis of readmissions we see that some of the ICB areas with the lowest readmission rates are those with higher mortality rates. Given that the risk of readmission will be strongly influenced by the mortality rate for this analysis we have excluded all those that died prior to readmission at either 28 days or 1 year. This gives us the risk of readmission for those that survived to the end of the time period of interest, either 28 days or 1 year.
Trends in the percentage of admissions with a subsequent readmission over time
Summary of percentage of patients readmitted within 1 year (2022/23)
All admissions are counted an individual events, so some patients with multiple admissions will be included more than once.
Elderly Emergency | Frail | Falls | |
|---|---|---|---|
Sex |
|
|
|
female | 137,552 (18%) | 81,461 (16.9%) | 11,819 (13%) |
male | 150,783 (23.7%) | 92,944 (21.6%) | 9,353 (21.4%) |
Age |
|
|
|
65-69 | N/A | 13,823 (12.4%) | 665 (7%) |
70-74 | N/A | 20,484 (14.4%) | 1,330 (9%) |
75-79 | 70,759 (16%) | 30,062 (16.4%) | 2,612 (11.4%) |
80-84 | 74,955 (18.9%) | 34,796 (19.1%) | 4,115 (14.8%) |
85-89 | 76,842 (23%) | 38,909 (23.1%) | 5,798 (18.4%) |
90+ | 65,779 (29.2%) | 36,331 (29.1%) | 6,652 (24%) |
Ethnicity |
|
|
|
Asian/Asian British | 7,018 (18.2%) | 4,431 (15.7%) | 351 (13.9%) |
Black/Black British | 3,524 (19.2%) | 2,179 (17.6%) | 178 (14.5%) |
Mixed | 669 (18.7%) | 479 (18.2%) | 46 (15.3%) |
Other | 2,802 (18%) | 1,717 (15.2%) | 203 (12.8%) |
White British | 241,639 (21.1%) | 145,474 (19.6%) | 17,898 (16.2%) |
White Other | 10,243 (20.6%) | 6,141 (18.8%) | 773 (15.3%) |
Unknown | 22,440 (18.1%) | 13,984 (16.3%) | 1,723 (12.7%) |
IMD decile |
|
|
|
1 | 26,455 (23%) | 17,160 (20%) | 1,834 (16.4%) |
2 | 27,277 (22.4%) | 17,521 (20.3%) | 2,145 (17.5%) |
3 | 27,735 (21.9%) | 17,417 (20%) | 2,126 (17%) |
4 | 28,717 (21.3%) | 17,295 (19.4%) | 2,134 (16.4%) |
5 | 29,722 (20.7%) | 17,854 (19.3%) | 2,088 (15.3%) |
6 | 30,450 (20.2%) | 18,229 (18.9%) | 2,263 (15.5%) |
7 | 30,769 (20%) | 18,049 (18.7%) | 2,203 (15.2%) |
8 | 30,652 (19.9%) | 18,040 (18.7%) | 2,245 (15.3%) |
9 | 29,339 (19.2%) | 17,166 (18.1%) | 2,151 (15%) |
10 | 27,219 (18.9%) | 15,674 (17.9%) | 1,983 (14.5%) |
|
|
| |
Total | 288,335 (20.6%) | 174,405 (19.1%) | 21,172 (15.8%) |
Comparing time to readmission between the cohorts using Kaplan-meier plots (2022/23)
Survival analysis was conducted where each admission is treated as an independent event. This means some patients who had multiple admissions within 2022/23 will be included multiple times.
Survival analysis was conducted using a patient’s first admission within 2022/23, so only one event is included per patient, even if the patient has multiple admissions over the year.
The risk of readmission is very similar between the elderly emergency and frail cohorts (note the frail cohort is a subset of the elderly emergency cohort). Those in the falls cohort have a lower risk of readmission.
The risk of admissions is increased slightly by a small subset of patients that have multiple readmissions, as the risk of readmission decreases if only the first admission/ readmission is included for each patient.
Kaplan Meier survival plots of time to readmission (2022/23)
For these plots each admission in 2022/23 was treated as an independent event, meaning that some patients who had multiple admissions within 2022/23 will be included multiple times.
ICB | Readmissions | No. at risk | Percentage |
|---|---|---|---|
QR1: NHS Gloucestershire ICB | 7,536 | 14,085 | 53.5 |
QT6: NHS Cornwall & Isles Of Scilly ICB | 6,608 | 12,168 | 54.3 |
QVV: NHS Dorset ICB | 14,615 | 26,857 | 54.4 |
QOC: NHS Shrops, Telford & Wrekin ICB | 7,780 | 13,660 | 57.0 |
QOX: NHS Bath & NE S'set, S'don & W ICB | 13,049 | 22,715 | 57.4 |
QGH: NHS Herefords & Worcestershire ICB | 11,353 | 19,501 | 58.2 |
QJM: NHS Lincolnshire ICB | 12,121 | 20,815 | 58.2 |
QMM: NHS Norfolk And Waveney ICB | 16,707 | 28,421 | 58.8 |
QJK: NHS Devon ICB | 21,309 | 35,933 | 59.3 |
QKS: NHS Kent And Medway ICB | 28,737 | 48,345 | 59.4 |
QJG: NHS Suffolk & North East Essex ICB | 16,823 | 28,277 | 59.5 |
QNX: NHS Sussex ICB | 28,783 | 48,358 | 59.5 |
QSL: NHS Somerset ICB | 11,011 | 18,439 | 59.7 |
QE1: NHS Lancashire & South Cumbria ICB | 27,919 | 46,422 | 60.1 |
QK1: NHS Leics, Leic'shire & Rutland ICB | 14,600 | 24,309 | 60.1 |
QU9: NHS Bucks, Oxford & Berkshire W ICB | 24,095 | 39,685 | 60.7 |
QUY: NHS Bristol, N S'set & S Gloucs ICB | 14,292 | 23,364 | 61.2 |
QOQ: NHS Humber And North Yorkshire ICB | 30,354 | 49,452 | 61.4 |
QRL: NHS Hampshire And Isle Of Wight ICB | 33,922 | 54,811 | 61.9 |
QMJ: NHS North Central London ICB | 12,725 | 20,531 | 62.0 |
QM7: NHS Hertfordshire & West Essex ICB | 22,891 | 36,862 | 62.1 |
QT1: NHS Nott'ham & Nottinghamshire ICB | 16,909 | 27,218 | 62.1 |
QH8: NHS Mid And South Essex ICB | 20,102 | 32,310 | 62.2 |
QYG: NHS Cheshire And Merseyside ICB | 43,565 | 70,074 | 62.2 |
QXU: NHS Surrey Heartlands ICB | 18,800 | 30,174 | 62.3 |
QWO: NHS West Yorkshire ICB | 32,610 | 52,301 | 62.4 |
QWE: NHS South West London ICB | 16,387 | 26,186 | 62.6 |
QWU: NHS Coventry And Warwickshire ICB | 16,321 | 25,980 | 62.8 |
QHG: NHS Beds, Luton & Milton Keynes ICB | 13,487 | 21,456 | 62.9 |
QOP: NHS Greater Manchester ICB | 40,307 | 63,630 | 63.3 |
QNC: NHS Staffordshire & Stoke-On-Tr ICB | 22,610 | 35,316 | 64.0 |
QHM: NHS North East & North Cumbria ICB | 62,301 | 96,995 | 64.2 |
QJ2: NHS Derby And Derbyshire ICB | 20,574 | 32,050 | 64.2 |
QUE: NHS Cambs & Peterborough ICB | 14,128 | 22,021 | 64.2 |
QUA: NHS Black Country ICB | 22,664 | 35,223 | 64.3 |
QHL: NHS Birmingham And Solihull ICB | 21,012 | 32,608 | 64.4 |
QMF: NHS North East London ICB | 18,425 | 28,158 | 65.4 |
QKK: NHS South East London ICB | 21,149 | 32,186 | 65.7 |
QRV: NHS North West London ICB | 28,701 | 43,514 | 66.0 |
QPM: NHS Northamptonshire ICB | 13,202 | 19,968 | 66.1 |
QF7: NHS South Yorkshire ICB | 26,747 | 40,369 | 66.3 |
ICB | Readmissions | No. at risk | Percentage |
|---|---|---|---|
QT6: NHS Cornwall & Isles Of Scilly ICB | 443 | 1,099 | 40.3 |
QR1: NHS Gloucestershire ICB | 572 | 1,326 | 43.1 |
QOC: NHS Shrops, Telford & Wrekin ICB | 518 | 1,180 | 43.9 |
QGH: NHS Herefords & Worcestershire ICB | 925 | 2,005 | 46.1 |
QJK: NHS Devon ICB | 1,380 | 2,925 | 47.2 |
QJM: NHS Lincolnshire ICB | 914 | 1,928 | 47.4 |
QK1: NHS Leics, Leic'shire & Rutland ICB | 1,024 | 2,117 | 48.4 |
QSL: NHS Somerset ICB | 857 | 1,752 | 48.9 |
QOX: NHS Bath & NE S'set, S'don & W ICB | 1,169 | 2,381 | 49.1 |
QMM: NHS Norfolk And Waveney ICB | 1,546 | 3,116 | 49.6 |
QE1: NHS Lancashire & South Cumbria ICB | 2,316 | 4,650 | 49.8 |
QVV: NHS Dorset ICB | 1,279 | 2,565 | 49.9 |
QOQ: NHS Humber And North Yorkshire ICB | 2,058 | 4,090 | 50.3 |
QJG: NHS Suffolk & North East Essex ICB | 1,420 | 2,808 | 50.6 |
QJ2: NHS Derby And Derbyshire ICB | 1,170 | 2,297 | 50.9 |
QT1: NHS Nott'ham & Nottinghamshire ICB | 1,293 | 2,534 | 51.0 |
QU9: NHS Bucks, Oxford & Berkshire W ICB | 1,857 | 3,638 | 51.0 |
QNX: NHS Sussex ICB | 2,673 | 5,229 | 51.1 |
QMJ: NHS North Central London ICB | 1,357 | 2,556 | 53.1 |
QWO: NHS West Yorkshire ICB | 2,757 | 5,162 | 53.4 |
QYG: NHS Cheshire And Merseyside ICB | 3,413 | 6,384 | 53.5 |
QKS: NHS Kent And Medway ICB | 1,790 | 3,275 | 54.7 |
QM7: NHS Hertfordshire & West Essex ICB | 2,077 | 3,785 | 54.9 |
QHM: NHS North East & North Cumbria ICB | 4,769 | 8,655 | 55.1 |
QOP: NHS Greater Manchester ICB | 3,351 | 6,069 | 55.2 |
QXU: NHS Surrey Heartlands ICB | 1,555 | 2,817 | 55.2 |
QUY: NHS Bristol, N S'set & S Gloucs ICB | 1,333 | 2,390 | 55.8 |
QUE: NHS Cambs & Peterborough ICB | 1,243 | 2,205 | 56.4 |
QWU: NHS Coventry And Warwickshire ICB | 1,411 | 2,492 | 56.6 |
QWE: NHS South West London ICB | 1,665 | 2,932 | 56.8 |
QHG: NHS Beds, Luton & Milton Keynes ICB | 1,363 | 2,397 | 56.9 |
QNC: NHS Staffordshire & Stoke-On-Tr ICB | 1,523 | 2,659 | 57.3 |
QRL: NHS Hampshire And Isle Of Wight ICB | 3,504 | 6,113 | 57.3 |
QH8: NHS Mid And South Essex ICB | 2,050 | 3,545 | 57.8 |
QF7: NHS South Yorkshire ICB | 2,098 | 3,610 | 58.1 |
QMF: NHS North East London ICB | 2,087 | 3,568 | 58.5 |
QUA: NHS Black Country ICB | 2,004 | 3,428 | 58.5 |
QHL: NHS Birmingham And Solihull ICB | 1,585 | 2,703 | 58.6 |
QRV: NHS North West London ICB | 2,484 | 4,211 | 59.0 |
QPM: NHS Northamptonshire ICB | 1,085 | 1,836 | 59.1 |
QKK: NHS South East London ICB | 2,701 | 4,393 | 61.5 |
ICB | Readmissions | No. at risk | Percentage |
|---|---|---|---|
QR1: NHS Gloucestershire ICB | 4,228 | 8,632 | 49.0 |
QT6: NHS Cornwall & Isles Of Scilly ICB | 3,711 | 7,478 | 49.6 |
QVV: NHS Dorset ICB | 8,209 | 16,329 | 50.3 |
QOC: NHS Shrops, Telford & Wrekin ICB | 4,528 | 8,677 | 52.2 |
QJM: NHS Lincolnshire ICB | 7,503 | 14,022 | 53.5 |
QOX: NHS Bath & NE S'set, S'don & W ICB | 7,642 | 14,207 | 53.8 |
QGH: NHS Herefords & Worcestershire ICB | 6,756 | 12,403 | 54.5 |
QMM: NHS Norfolk And Waveney ICB | 9,939 | 18,153 | 54.8 |
QJK: NHS Devon ICB | 11,795 | 21,430 | 55.0 |
QSL: NHS Somerset ICB | 6,408 | 11,654 | 55.0 |
QK1: NHS Leics, Leic'shire & Rutland ICB | 8,620 | 15,595 | 55.3 |
QKS: NHS Kent And Medway ICB | 15,240 | 27,267 | 55.9 |
QNX: NHS Sussex ICB | 17,627 | 31,476 | 56.0 |
QE1: NHS Lancashire & South Cumbria ICB | 17,292 | 30,821 | 56.1 |
QOQ: NHS Humber And North Yorkshire ICB | 17,908 | 31,735 | 56.4 |
QJG: NHS Suffolk & North East Essex ICB | 9,957 | 17,584 | 56.6 |
QU9: NHS Bucks, Oxford & Berkshire W ICB | 14,508 | 25,628 | 56.6 |
QUY: NHS Bristol, N S'set & S Gloucs ICB | 8,589 | 14,929 | 57.5 |
QHG: NHS Beds, Luton & Milton Keynes ICB | 7,890 | 13,670 | 57.7 |
QH8: NHS Mid And South Essex ICB | 12,405 | 21,477 | 57.8 |
QM7: NHS Hertfordshire & West Essex ICB | 13,661 | 23,592 | 57.9 |
QT1: NHS Nott'ham & Nottinghamshire ICB | 10,598 | 18,298 | 57.9 |
QXU: NHS Surrey Heartlands ICB | 11,263 | 19,424 | 58.0 |
QYG: NHS Cheshire And Merseyside ICB | 28,643 | 49,417 | 58.0 |
QMJ: NHS North Central London ICB | 7,835 | 13,474 | 58.1 |
QWO: NHS West Yorkshire ICB | 21,149 | 36,388 | 58.1 |
QOP: NHS Greater Manchester ICB | 25,398 | 43,396 | 58.5 |
QWE: NHS South West London ICB | 10,505 | 17,934 | 58.6 |
QRL: NHS Hampshire And Isle Of Wight ICB | 19,996 | 34,051 | 58.7 |
QHM: NHS North East & North Cumbria ICB | 38,226 | 64,989 | 58.8 |
QWU: NHS Coventry And Warwickshire ICB | 10,084 | 17,073 | 59.1 |
QHL: NHS Birmingham And Solihull ICB | 12,589 | 21,220 | 59.3 |
QUA: NHS Black Country ICB | 14,078 | 23,726 | 59.3 |
QNC: NHS Staffordshire & Stoke-On-Tr ICB | 14,100 | 23,730 | 59.4 |
QUE: NHS Cambs & Peterborough ICB | 8,631 | 14,278 | 60.4 |
QRV: NHS North West London ICB | 17,874 | 29,550 | 60.5 |
QJ2: NHS Derby And Derbyshire ICB | 12,595 | 20,681 | 60.9 |
QMF: NHS North East London ICB | 11,629 | 19,004 | 61.2 |
QF7: NHS South Yorkshire ICB | 15,994 | 26,096 | 61.3 |
QKK: NHS South East London ICB | 14,163 | 22,840 | 62.0 |
QPM: NHS Northamptonshire ICB | 8,464 | 13,426 | 63.0 |
Multivariate survival analysis of time to readmission (2022/23)
For this analysis we have taken only data from 2022-2023, and only the first admission/time to readmission for each patient.
We have fitted Cox proportional hazard models to our data to assess how various factors independently affect the risk of readmission occurring over time.
For information on the testing of the proportional hazards assumption see Section 1.5.1.
We have used a Cox proportional hazards models and the calculated hazard ratios can be considered as a time-averaged hazard ratio. We have considered models for readmission within 28 days and within 1 yr. There are some differences between the hazard ratios calculated for the two models, but the general trends are consistent.
Elderly emergency
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 0.1925 1 0.6608
age_range 0.0028 1 0.9580
ethnicity 0.3260 1 0.5680
imd_decile 0.3230 1 0.5698
icb 20.5807 1 0.0000 *
GLOBAL 657.5789 59 0.0000 *
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 166.1685 1 0.0000 *
age_range 90.2829 1 0.0000 *
ethnicity 0.7149 1 0.3978
imd_decile 15.9585 1 0.0001 *
icb 2.1304 1 0.1444
GLOBAL 2028.8874 59 0.0000 *
Falls
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 2.8978 1 0.0887
age_range 46.2675 1 0.0000 *
ethnicity 0.0725 1 0.7877
imd_decile 0.3218 1 0.5706
icb 11.3693 1 0.0007 *
GLOBAL 114.7952 61 0.0000 *
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 0.5071 1 0.4764
age_range 580.2587 1 0.0000 *
ethnicity 0.0239 1 0.8770
imd_decile 0.2608 1 0.6095
icb 8.2191 1 0.0041 *
GLOBAL 124.2188 61 0.0000 *
Frail
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 1.0416 1 0.3074
age_range 7.0704 1 0.0078 *
ethnicity 0.3923 1 0.5311
imd_decile 0.2569 1 0.6122
icb 83.2885 1 0.0000 *
GLOBAL 540.8746 61 0.0000 *
Forest plot of hazard ratios. Black indicates no significant difference compared to the reference group, red indicates a significant increase in the hazard ratio (risk) and green indicates a significant decrease. The size of the point gives an indication of the relative number of people in each group.
chisq df p sig
sex 107.2706 1 0.0000 *
age_range 6702.7256 1 0.0000 *
ethnicity 0.8407 1 0.3592
imd_decile 14.4995 1 0.0001 *
icb 1.6387 1 0.2005
GLOBAL 2143.9871 61 0.0000 *
Conclusions
Following an emergency admission the risk of both death, and readmission (in those who do not die within the follow-up period), in all 3 cohorts (elderly emergency, falls or frail) was higher for males, those living in more deprived areas and those who were older at admission.
There was also significant variability in risk of death and readmission between ICB area, even once any differences in the age, ethnicity, sex and deprivation of the areas were accounted for in this analysis.
The risk of death in the year post-admission was lower for those who were Asian/Asian British, Black/Black British or Other ethnicities, compared to White British. There is a general trend towards a higher risk of readmission for those who are White British than those of other ethnicities. In the elderly emergency and frail cohorts the risk of readmission was lower in those who were Asian/Asian British, Black/Black British, Other and Unknown ethnicity. For the falls cohort there are less differences between ethnic groups, but in the 1 year post-admission analysis the risk of readmission is also significantly lower in those who are Asian/Asian British, from Other or Unknown ethnic backgrounds.